Method for predicting disseminated encephalomyelitis development course and outcome in children and teenagers

FIELD: medicine.

SUBSTANCE: method involves carrying out magnetic resonance tomography examination. Focal neurological brain disorders symptoms with growth to 10 days, process stabilization to 14 days and discovering isolated lesions in brain and spinal cord sized to 1.0 cm and having regular round and ovoid shapes with uniform, moderate intensity magnetic resonance signal on magnetic resonance tomograms being observed on the background of general infectious and moderately expressed neurological disorders, acute development course with complete recovery and no neurological deficiency is to be predicted. Neurological symptoms being observed on the background of lacking general infectious and general cerebral disorders with focal lesions increasing during 3 weeks with alternating short stabilization period and rapid arrival of new neurological disorders with pathological magnetic resonance signal foci being 1.5 to 6 cm large and having irregular heap-shaped forms fusing to each other with signals not uniform in intensity on magnetic resonance tomograms, subacute development course with moderate residual neurological deficiency is to be predicted in all patients. Slow (from 1 to 6 month long) neurological symptoms development of the disease being detected with torpid growth period and transition to relative stabilization period characterized with neurological disorders progress becoming slow, with diffuse zones of pathologically changed magnetic resonance signal from brain substance being observed on magnetic resonance tomogram, chronic development course accompanied with progradient disease pattern and development of hard multiple-syndrome neurological deficiency and resistant epilepsy in outcome is to be predicted.

EFFECT: high accuracy of prognosis.

 

The invention relates to medicine, namely to diagnosis. Determination of the nature of the disease and early prediction of outcome allows you to optimize therapy to reduce the severity of neurological disorders at all stages of the infection process.

Scattered encephalomyelitis in children and adolescents presents sporadic inflammatory diseases of the Central nervous system that occur with a primary lesion of the white matter of the brain and/or spinal cord. The disease is different etiology; different viruses and bacteria under certain conditions can lead to the development of encephalomyelitis. Significance of the problem of the scattered encephalomyelitis in children and adolescents due to the growth of this disease in recent years, the trend for heavy current with frequent disability and transition in the chronic form. A significant difficulty is the clinical polymorphism of the disease, causing difficulty in delivering differentiated treatment for different nature of the pathologic process, which significantly limits its possibilities and worsens the outcome.

In this regard, there is no doubt the need for accurate prediction of the nature of the flow scattered encephaloma the comrade in children and adolescents to improve outcomes through the application of differential treatment.

Known very few methods of separation of encephalomyelitis on various clinical signs, with a predictive nature. Attempted separation of encephalomyelitis on the nature of the flow and form of the disease is given in Zshmodules. “The primary infectious-allergic encephalomyopathies”, M., 1997. The author on the basis of clinical manifestations, historical data and changes electroneuromyographic indicators divides the disease into acute and protracted, paralytic and nephrolithiasis form. Despite the clarity of the proposed criteria, the work is rather original classification approach than a method of predicting the course of encephalomyelitis, as the analysis undertaken has not prospectively and retrospective in nature. In addition, the research material in the work Sceneis served adults, which does not allow to use the results presented for predicting the course of encephalomyelitis in children and adolescents. Closest to the proposed method, is a method of predicting the course of encephalomyelitis in children are presented in Apinedo Acute neuroinfections in children L., 1986. Based on the analysis of the characteristics of the infectious process, namely depending on the epidemiological'am is ESA, the nature and duration of fever, catarrhal phenomena, time of occurrence and type asanteni rashes, as well as the time from the beginning of the first symptoms before the appearance of neurological disorders, the author offers a number of prognostic criteria that predict the severity and outcome of disease. However, the disadvantage of this method is the lack of complexity of the proposed criteria (considered only clinical-anamnestic signs) and a clear division on the nature of the flow of encephalomyelitis. This substantially limits the ability to accurately forecast the trends and outcomes of the scattered encephalomyelitis in children and adolescents, which does not allow adequate correction therapy.

The elimination of these disadvantages can help authors suggest a method for predicting the course and outcome of the scattered encephalomyelitis in children and adolescents.

The technical result of the present invention is to improve the accuracy of predicting the course and outcome of the scattered encephalomyelitis in children and adolescents. This result is achieved by the fact that the prediction is based on a comprehensive analysis of clinical and historical features of the disease and the changes in the substance of the brain and spinal cord detected by the method of magnetic resonance imaging.

Accom is emy method of predicting the course and outcome of the scattered encephalomyelitis in children and adolescents differs when you see a background obstipation and mildly cerebral symptoms focal neurological disorders with an increase of up to 10 days, the stabilization process up to 14 days and identify on MRI lesions in the brain and/or spinal cord in the amount of up to 1.0 cm with the correct rounded-ovoid forms, located on the reservation, with uniform moderate intensity magnetic resonance signal, predict a severe course with complete recovery without neurological deficit. When neurological symptoms in the absence of obstipation and cerebral symptoms with increasing focal violations within 3 weeks with alternating short period of stabilization with the rapid appearance of new neurological disorders, with detection on MRI pathological lesions magnetic resonance signal size from 1.5 to 6 cm with the wrong “principal” forms, merging among themselves with inhomogeneous intensity signal, predict subacute course with the formation of a moderate residual neurological deficits in all patients. When slow (from 1 to 6 months) the development of neurological symptoms with torpid period of growth and transition into a period of relative stability, in which the progression of neurological disorders slows down, with the phenomenon on MRI diffuse zones of the pathologically changed signal from the brain, predict a chronic course with progredient disease and formation in the outcome of the rough palindromes neurological deficit and drug-resistant epilepsy.

The proposed method of forecasting based on the comprehensive assessment of both clinical-anamnestic criteria, reflecting the nature of the infection process, and the changes in the substance of the brain and spinal cord detected by the method of magnetic resonance imaging, reflecting the depth and prevalence of pathological inflammatory changes in the Central nervous system. In infectious diseases of importance severity obstipation symptoms (fever, myalgia, catarrhal phenomena) reflecting the adequacy of the response of a microorganism to an infectious agent. Early and adequate response is accompanied by the appearance obstipation symptoms, which, in turn, to the emergence of cerebral events (headache, nausea) and their presence in the anamnesis of encephalomyelitis causes acute course with a favorable outcome. On the contrary, the absence of obstipation symptoms is a sign of areactively and in their absence predict a chronic course of encephalomyelitis.

Not less important feature, which has great prognostic value, the value is the frequency of the disease, the OTP is concerned with the stages of sanogenesis (recovery). Pronounced periodicity within encephalomyelitis short period of growth (up to 10 days) and the short stabilization period (up to 14 days), passing in the recovery period, due to the favorable type of organism response to the infectious agent and the adequacy of reparative reactions, whereas, the absence of periodicity in their development is the result of a failure or lack of repair processes that serves as a basis for predicting acute and chronic, respectively.

A key moment in the proposed method of predicting the course and outcome of the scattered encephalomyelitis in children and adolescents is to evaluate the changes in the substance of the Central nervous system by the results of the MRI, what distinguishes the proposed method for the prediction from previously used.

Modern diagnostic criteria of the scattered encephalomyelitis require confirmation of the clinical diagnosis by MRI of the brain and/or spinal cord, and without considering the peculiarities of magnetic resonance images of pathological changes in the Central nervous system cannot be implemented accurately predicting the course and outcome of the disease. It is universally accepted that position, according to which the limiting inflammatory the process within a small area (up to 1 cm) is a favorable type of response, while the distribution of pathological changes on longer stretches (>1.5 cm) with localizing failure mechanisms (wrong form foci, foci merge between them adversely. The least favorable is the diffuse type of pathological changes in the Central nervous system, which limits the inflammatory process does not occur. In the proposed method for predicting the small size of the lesions (up to 1 cm) with the correct forms and isolated location is the basis for the prediction of acute course with complete recovery; large foci (1.5-6 cm) with irregular forms a drain-type configuration allows to predict the subacute period without full recovery; and areas of diffuse abnormal signal in the brain substance allows to predict chronic progredient course of the disease. Presents magnitotelluricheskie criteria predicting the course and outcome of encephalomyelitis fully consistent with modern concepts of disease pathogenesis. The described method is supported by examples of specific use.

Example No. 1. Patient D. 6 years no history 7313. The child is acutely ill with rise of temperature up to 38°, chills in the background and then on the third day from the onset of the disease appeared elenagolova pain, repeated vomiting. Have any vision due to divergent strabismus, weakness in the lower extremities. Neurological disorders increased during the 7 days. On brain MRI performed on the 10 day of the disease revealed multiple foci of abnormal magnetic resonance signal in the white matter of the hemispheres, the legs of the brain, the cerebellum. Their size did not exceed 1.0 cm, was located foci are separated and have a rounded form, characterized in that moderate intensity signal. On the basis of the proposed method for predicting the child was previously diagnosed with disseminated encephalomyelitis acute course and a favorable outcome. Further on the background of therapy after clinical stabilization within 12 days there has been a rapid regression of neurological disorders and ended within 3 months of full recovery. The control MRI after 3 months and 1 year from the onset of pathological changes were not found.

Example No. 2. Patient W. 8 years, no history of the disease 6431. A child becomes ill gradually: in the absence of temperature is observed generalized tonic-clonic seizure occurs unstable walking, speech by type of motor aphasia. Neurological disorders dig for 18 days. MRI revealed a large, up to 6 cm, the PE the GI pathological signal in both hemispheric brain irregular shape, merging among themselves. On the basis of the proposed method for predicting the child was previously diagnosed with disseminated encephalomyelitis with a subacute course and the formation of residual neurological deficit. Further on the background of therapy was observed periods of deterioration of a total duration of up to 4 months. The outcome of the disease, the child has formed a residual deficit in hyperkinetic and epileptic syndromes. The control MRI performed after 3 months and 1 year from the onset of the disease remained zone pathological signal with the reduction of their area in the dynamics of the observation.

Example No. 3. Patient, 12 years old, no history of the disease 6154. Healthy 12 year old boy on a background of full health became worse learning, behavior changed, became silly. The disease progressed very slowly: broken hand, began to grow intellectual-mnestic disorders. MRI revealed diffuse signal change from the brain substance. On the basis of the proposed method for predicting the child was previously diagnosed with disseminated encephalomyelitis with a chronic course and poor prognosis. Further, it was noted the increase in neurological disorders, appeared resistant to attacks by the care is, developed gross mental retardation to the extent of heavy imbecility. The control MRI of positive changes was not determined.

The effectiveness of the proposed method of prediction is confirmed by the following provision: before introduction into the clinic of the CNS NEEDY of the proposed method for predicting the course and outcome of the scattered encephalomyelitis in children and adolescents was conducted routine clinical-anamnestic method, the accuracy of which does not exceed 65%, while therapy in 35% was not fully adequate, which corresponded to a 20% unsatisfactory results of treatment with the formation of a pronounced residual deficit.

Introduction in the proposed method of predicting the course and outcome of the scattered encephalomyelitis in children and adolescents allowed to reach 90% accuracy prior forecast, which resulted in reduction of inadequate therapy up to 10% and reduce by half (to 10%) level of disability. The proposed method of forecasting was applied in 30 children with various for disseminated encephalomyelitis, with the accuracy of a predictor was 90%.

This method of predicting the course and outcome of the scattered encephalomyelitis in children and adolescents can be used in the work of infectious and neurological departments detsk the x hospitals.

A method for predicting the course and outcome of the scattered encephalomyelitis in children and adolescents through integrated clinical-anamnestic analysis, characterized in that conduct magnetic resonance imaging (MRI) and when you see a background obstipation and mildly cerebral symptoms focal neurological disorders with an increase of up to 10 days, with stabilization process up to 14 days and identify on MRI lesions in the brain and/or spinal cord in the amount of up to 1.0 cm, with the correct rounded-ovoid forms, located on the reservation, with uniform moderate intensity magnetic resonance signal, predict a severe course with complete recovery without neurological deficit; when neurological symptoms in the absence of obstipation and cerebral symptoms with increasing focal violations within 3 weeks with alternating short period of stabilization with the rapid appearance of new neurological disorders, with detection on MRI pathological lesions magnetic resonance signal by 1.5 - 6 cm with the wrong “principal” forms, merging among themselves with inhomogeneous intensity signal, predict subacute course with the formation of a moderate residual neurological deficits in all patients; slow is t 1 to 6 months development of neurological symptoms with torpid period of growth and transition into a period of relative stability, in which the progression of neurological disorders slowed down, with detection on MRI diffuse zones of the pathologically changed signal from the brain, predict a chronic course with programmesto disease and formation in the outcome of the rough palindromes neurological deficit and drug-resistant epilepsy.



 

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